Provider Demographics
NPI:1528568029
Name:NG, JYE SHUANG
Entity Type:Individual
Prefix:
First Name:JYE SHUANG
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JYE SHUANG
Other - Middle Name:
Other - Last Name:NG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATHLETIC TRAINER
Mailing Address - Street 1:509 VERNON ST
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-4538
Mailing Address - Country:US
Mailing Address - Phone:903-752-9064
Mailing Address - Fax:
Practice Address - Street 1:403 MAIN ST
Practice Address - Street 2:
Practice Address - City:GRAMBLING
Practice Address - State:LA
Practice Address - Zip Code:71245-2715
Practice Address - Country:US
Practice Address - Phone:318-247-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA3015402255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer